Information about an Adult's Post-Mortem Examination - more detail about authorisation, the examination, tissue blocks and uses of the medical record

Post-Mortem Examination of an Adult

Basic Information Leaflet

Summary

The post-mortem examination is an important medical examination to find the cause of a person's death.

The person's own wishes should take priority about whether or not post-mortem examination takes place.

If the person asked someone else to make such decisions (a nominated representative), he or she will be asked to consider authorising a post-mortem examination.

If the deceased left no instructions and there is no nominated representative, the nearest relative will be asked whether he or she wishes to authorise a post-mortem examination. There are rules that set out who the nearest relative is.

Ideally the post-mortem examination should take place within a day or two of death.

The person's face, hands and feet are not normally affected by the post-mortem examination.

Relatives should be able to see the body again after the post-mortem examination.

The final results of the examination will usually be available in 21 days and a copy is sent to the deceased's general practitioner. Unless the deceased did not wish this, a copy of the report can be requested by the nominated representative/nearest relative.

Whole organs will only be kept if this was the deceased person's wish or we have authorisation from the nominated representative/nearest relative.

If the nominated representative/nearest relative does not wish to authorise a full post-mortem examination, there may be other tests that may be done. This should be discussed with hospital staff.

Ask as many questions as you wish.

Information about an adult's post-mortem examination

We understand that this is a difficult time for you and it may be hard to consider a post-mortem examination. This leaflet has been written (with the help of bereaved relatives) to give you clear information about the reasons for doing a post-mortem examination and what you would need to decide.

About the authorisation form

Unless it has been ordered by the Procurator Fiscal, the doctors need authorisation before they can carry out a post-mortem examination. If the deceased has left clear instructions that he or she authorises a post-mortem examination and what can be done with his or her body, then these instructions take priority. If he or she had authorised a post-mortem examination, it can take place even if relatives object.

The deceased may have chosen someone else to make such decisions instead. If the hospital knows who this person is, he or she would be the deceased's nominated representative and would be asked whether or not a post-mortem examination should go ahead. The nominated representative can authorise a post-mortem examination even if relatives object.

If the deceased left no instructions and did not nominate someone else to make these kinds of decision, the nearest relative will be the person who is asked to consider authorising a post-mortem examination. There are rules which set out who the nearest relative is and these will be explained to you. You should let hospital staff know if you think there is a nearer relative than you, or if there are other people who you think should be involved in making this kind of decision.

If you have been given this form it is because the hospital thinks you are the deceased's nominated representative or nearest relative and that you are the person who should be asked whether or not to authorise a post-mortem examination. A written record of your decision makes it clear to everyone what you have, and have not, agreed to. If you change your mind before the post-mortem has taken place you can withdraw your authorisation _ even after signing. The hospital staff will tell you how much time you have in which to do this, and who you should contact.

Important: before going on with this leaflet, if you are not sure whether you are the person who should be asked to authorise post-mortem examination, because you are not sure you are the person's nominated representative or nearest relative, please explain this and check with hospital staff.

What do I need to know?

People have different views on how much information they want about a post-mortem examination. You should ask

as many questions and read as much information as you want.

You may not want to know any more about the post-mortem examination, but would still be willing to authorise it. If, on the other hand, you would like more detail or would like to discuss it with another health professional (such as a pathologist), please ask. There is a second leaflet with more detailed information about what is involved in post-mortem examinations. Let us know if you want to have this.

Why do a post-mortem examination?

A post-mortem examination can provide information about the illness or other cause of a person's death. Sometimes families ask questions that can only be answered with information from a post-mortem examination. It is also possible that the information gained may benefit other families who suffer from similar problems in the future. The post-mortem findings are also very important for the staff who cared for the person who has died. They can use the knowledge to learn about disease and possibly help others in the future. However, even a post-mortem examination can not always provide a reason for the death. The main reasons for a post-mortem examination are to:

identify the cause of death;

confirm the nature of the illness if this is not already known;

identify conditions that may not have been diagnosed;

identify complications or side-effects of treatments and drugs; and

diagnose and treat conditions that might affect other members of the family.

The following notes refer to sections in the authorisation form for post-mortem examination.

SECTION 1 Authorisation of a post-mortem examination

What happens in a full post-mortem examination? (Section 1a)

A full post-mortem examination includes an external and an internal examination. It is done with the same care that would be used if the person were having an operation. If you wish to have a more detailed explanation of a full post-mortem examination, please see the other leaflet. Small tissue blocks and slides, photographs and X-rays will be made and may be kept as part of the medical record. The person's face, hands and feet will not normally be affected by the examination and you should be able to see the body afterwards if you wish.

Are there different options available? (Section 1b)

If you do not want to agree to a full post-mortem examination, you might consider a limited examination. The doctor or other health professional who discusses the post-mortem with you will be able to explain what the options are. Usually, it means that only certain parts of the body are examined. Tissue block samples and slides, photographs and X-rays may be made in the same way as for a full post-mortem examination.

However, limited examinations provide only limited information about cause of death or illness. A full post-mortem examination will always provide more information. Hospital staff may advise that a limited examination would not provide any useful information and so should not be undertaken.

Since the person's own wishes about what he or she wished to happen have most importance, you will be asked if you know whether the deceased left any instructions about post-mortem examination, or if you think he or she would have objected to it. If there were instructions, these will be checked and if the deceased would have objected then the post-mortem examination would not take place.

When is a post-mortem done?

Post-mortem examinations are usually carried out within 1-3 working days of death occurring. They take place in the mortuary. If, because of the person's religion, the funeral must be within 24 hours, please let us know; we will try to undertake the post-mortem within this time.

What happens in a post-mortem examination?

A post-mortem examination is done with the same care that would be used in an operation. It includes an external and an internal examination. If you wish a detailed explanation, please see the other booklet. The person's face, hands and feet will not normally be affected by the examination.

Section 2 Authorisation of uses of the medical record

What can be done with the medical record?

Tissue blocks and slides, photographs, X-rays and other images taken during the post-mortem examination will form part of the person's medical record. Unless the deceased had objected to information being shared with the family, they may be useful for the family in future, for example, to diagnose conditions in other family members or if more information becomes available about the condition the person may have had.

They could also be used for medical education and audit. Medical education includes teaching and training all types of doctors, nurses and health professionals so they can provide the best care for patients in the future. Audit means checking the quality of care, procedures and tests to make sure they continue to meet the highest standards.

The medical record can also be used for medical research that may benefit other patients. For example, when a new disease or health problem emerges, examining tissue on a wide scale may provide clues about how and why the disease emerged - and how to respond. This happened with the disease known as variant CJD after the BSE scare in cattle.

If any photographs could identify the person, you would be asked specifically for your permission before they are used unless the deceased person had authorised this use. If extra tissue or images are requested specifically for education, audit or research you would be asked to give separate permission for this, again unless the person had authorised this to be done.

What are tissue samples, blocks and slides?

Although some information can be obtained from looking directly at organs and tissues in a post-mortem examination, often the only way to understand properly what has happened is to look at small tissue samples under the microscope. These samples are very small, slightly thicker but no larger than a standard postage stamp. (For more detailed information please see the second leaflet.)

Section 3 Retention and examination of organs

Will any organs be kept?

There may be benefits in keeping a whole organ to carry out a more detailed examination. This will usually be the case if there is an abnormality of the brain, but sometimes the pathologist may need to examine a heart or other organs with an abnormality. Organs will not be retained without the deceased's or your authorisation. (For more information on retention and examination of organs, see the second leaflet.)

If this is discussed with you, there are a number of other options to consider, such as what happens to the organs afterwards. If the person had left instructions about these matters, the hospital will follow these instructions.

Section 4 Other requests or conditions

Can I make any conditions?

If you wish to make any special request or condition, please say so in section 3, for example, if there are religious requirements that you need to have followed or you wish to allow some organs to be used for research but not others.

What happens after the examination has been completed?

Great care is taken during and after the examination so that the body can be seen after the examination and dressed in his/her clothes. The skin and colouring will naturally change after death whether or not a post-mortem examination has been carried out.

Can I find out the results of the post-mortem examination?

Yes, unless the deceased wished his or her medical information to remain confidential. The pathologist will write a preliminary report within 2 days but some tests may take a few weeks, and a final report will be sent to the doctor who had been caring for the person within 21 days. A copy will be sent to the deceased's general practitioner (GP). You may be offered an appointment to discuss the results, or you may wish to see the GP. You can ask for a copy of the report.

What should I know before deciding?

You should take as much time as you require to make a decision although in practice there is a time limit because of natural changes that take place after death. Also some tests are better done sooner rather than later (see summary). The hospital staff should make sure you have enough information to decide whether you wish to give your authorisation. They will discuss the alternatives with you. Although they may recommend a particular option, it is important that you understand and come to your own decision. They will ask you to say whether you have understood the information you have been given. If you are not sure, say so.

If you change your mind before the post-mortem examination has taken place you can withdraw your authorisation. The hospital staff will tell you how much time you have in which to do this, and who you should contact. If you give your permission for use of the medical record or organs, permission can be withdrawn at any time unless the medical records or organs have already been used for authorised purposes. Again, you will be told who you should contact.

We hope this information is helpful but please ask if there is more information you need.